BULGE: Some hernias form a bulge, a lump or a protrusion that can be seen or felt sticking out of the abdominal wall. There may be no associated pain and often it is an incidental finding noted by the patient’s doctor on a routine physical exam, or even on an X-RAY or CAT scan or ultrasound done for a different reason. Many patients notice a bulge, have no pain, and observe it for many years. In some cases the hernia gets larger, but in others it stays the same size.

PAIN: Pain may be present in patients with hernias. The pain may be related to local pressure and stretching as the hernia contents squeeze through the hernia defect, or are pushed back in. It may be related to the stretching or squeezing of the actual hernia contents, such as intestine, as they come out from inside.

In inguinal hernias, there are sensory nerves that run through the same opening as the hernia, and may be compressed or irritated – this can cause local pain or pain that radiates up to the thigh or hip area, or down to the scrotum or testicle or into the labia area in females. The pain can be aching, or sharp or burning.

The size of the hernia does not always correlate to the amount of pain – it may be related to the size of the defect and what is coming through – a small defect which creates a tighter opening may be more symptomatic than a large one where the contents can go in and out with little pressure or resistance. In some cases, intestine inside the hernia may not function normally or be partially blocked, and it may cause symptoms elsewhere inside the abdomen due to cramps or gas. Some patients will get relief by pushing the hernia contents back inside or reducing it.

ASYMPTOMATIC HERNIAS

Some patients will have a hernia diagnosed as an incidental finding on a CT scan or Ultrasound done for another reason. They do not have a noticeable bulge or any pain. Others may have a small bulge without any pain. These patients can sometimes be managed conservatively with a program of “watchful waiting”.